I just got off the phone with a family member whose mother is currently on the rehab side of a facility, and he’s genuinely trying to do the right thing. He started looking into private caregivers as an alternative. Here’s the kicker: the home health agency quoted him a monthly rate nearly identical to what the facility is charging. At the same time, the facility is pushing him hard to “get her Medicaid in order” so they can move her straight into long-term care once insurance stops paying for rehab. The home health agency gave him the exact same answer — not because it benefits the patient, but because they need Medicaid to keep billing. And the people actually doing the hands-on care? They’re being paid $13–19 an hour. Let that sink in.
This is how broken the system is in Virginia and nationwide. Corporations charge eye-watering amounts, funnel everyone toward Medicaid, underpay the workforce, understaff the floors, and pocket the difference — all while families are told this is “just how it works.” And instead of demanding nursing admissions reform, mandatory staffing ratios, and caps on what these companies can extract, we keep letting it slide.
So let’s talk numbers — because this is where the scam lives.
People love to say, “Well, it costs a lot to run these places.”
Yes. It does.
But not like they want you to believe.
🏥 Corporate Nursing Homes: The Reality
A typical skilled nursing facility’s real operating costs include staff wages (CNAs, nurses, therapy), food, laundry, housekeeping, utilities, maintenance, insurance, supplies, and administrative salaries. Labor is the biggest expense — and it’s the first thing they cut. CNAs make roughly $15–20 an hour. Nurses are stretched thin. Ratios are unsafe. Supplies are rationed.
Yet facilities bill $400–$700 per day per resident, often $12,000–$20,000+ per month, with rehab days billed even higher. After expenses, many corporate chains still clear 10–25% profit margins — even after executive bonuses and corporate overhead. That profit doesn’t come from efficiency. It comes from understaffing, underpaying, and overbilling.
🏠 Home Health Agencies: Not the Saints Either
Home health agencies have far lower overhead. Their costs are caregiver wages ($13–19/hr), payroll taxes, insurance, minimal admin staff, scheduling software, and mileage. They don’t maintain buildings. They don’t provide meals. They don’t do 24/7 care.
Yet they bill $30–45+ per hour, often totaling monthly costs comparable to facilities. When they say, “You’ll need Medicaid so we can continue services,” what they really mean is: “We need guaranteed billing — not better care.”
💰 Follow the Money
The caregiver doing the work gets $15 an hour.
The family pays $35–45 an hour.
The difference does not go to better staffing, training, or patient care.
It goes to corporate profit, executive salaries, shareholders, and expansion.
Meanwhile, families are drained, staff burn out, and residents suffer.
Why This Matters
If this system were truly about care, we’d already have mandatory staffing ratios, admissions reform to stop inappropriate placements, caps on profit extraction, and wage floors tied to billing rates. We don’t — because the system is working exactly as designed, just not for patients or workers.
This isn’t a staffing shortage.
This isn’t a funding problem.
This is a priorities problem.
And until we demand transparency, staffing mandates, and limits on how much corporations can extract from elder care, the same people will keep paying the price: the elderly, their families, and the workers holding this entire system together with duct tape and caffeine